A review of 18 consecutive planned Charcot reconstructions (8 midfoot, 2 hindfoot, 8 combined) with at least a year of follow-up. Guidelines suggest waiting until HbA1c is below 8.5%; seven of these patients did not reach that target and the team went ahead anyway. There were four complications, all settled without further surgery, and no kidney or heart complications. At one year 11 patients (61%) were walking in shoes, and results did not differ between those who met the target and those who did not.

A review of bone infection in the diabetic foot, written for surgeons. It covers diagnosis with MRI, bone scans and bone biopsy, culture-guided antibiotics often given for long periods, and surgery ranging from drainage to debridement and bone resection. It also sets out how recurrence is prevented: glucose control, foot care, patient education, restoring blood supply where needed, and early review of any new wound.

Around a third of Charcot deformities needing limb salvage involve both the hindfoot and the midfoot. This paper describes the technique — hindfoot first, then midfoot, with long rigid internal fixation — in 34 patients (35 feet) treated between 2009 and 2019, eleven of them in two stages because of active infection. At a mean of 53 months, 11 of 13 ulcers had healed and 33 feet were fully weight-bearing in surgical shoes or a brace. Metalwork failed in five feet and four patients needed revision.

An invited review of what causes Charcot arthropathy, the factors that influence the outcome of treatment, and what the condition costs health systems. Surgery for Charcot is becoming more common, driven by rising prevalence, a better understanding of the cause, and better identification of the patient factors that can be improved before an operation.

Seventy hindfoot reconstructions with an intramedullary nail between 2007 and 2019, followed for a mean of 54 months. The hindfoot fused in 83% and 74% were fully weight-bearing at final review. Age, weight, HbA1c and previous vascular surgery made no difference to union. What did: a nail that filled the tibial canal, an additional hindfoot compression screw (95% union against 78%), and an intact medial malleolus. Metalwork failed in 19%. These findings shape how the construct is built.

A step-by-step account of the operation for the collapsed Charcot ankle and hindfoot: assessment, planning and timing, the approaches and bone cuts, nail insertion and locking, and the additional screw or plate that adds rotational stability. It is written to shorten the learning curve for other surgeons.

Forty studies reviewed. Complications after an ankle fracture are more common in diabetes, and more common again when diabetes is poorly controlled, insulin-dependent or complicated by neuropathy or vascular disease. Non-operative treatment did poorly. Supplementary fixation was associated with fewer complications. In stable fractures without neuropathy, early weight-bearing gave results similar to people without diabetes. External fixators as definitive treatment carried high complication rates.

Every published series of Charcot reconstruction from 1993 to 2018: 1,116 feet in 1,089 patients. Internal fixation was used in 65%, external fixation in 31% and both in 4%, with no technique clearly better than another. Overall bone fusion was 86%, a technique-related complication occurred in 36%, the amputation rate after reconstruction was 5.5% and 91% returned to walking. The authors note that the quality of the evidence is low.

A review of 30 admissions in 19 complex patients needing surgery for infected ulcers, Charcot deformity or both, managed by the multidisciplinary team as a series of key events with close microbiological and blood-test monitoring. There were three minor amputations and no major amputations. Podiatry swabs matched the surgical bone specimen in only two of nine pairs, which is the reason bone is sampled.

The first nine patients (ten feet) in whom a single 6 mm bolt was used to fuse the inner column of the foot. The deformity was corrected well — the mean Meary angle improved from 26° to 1° — but in all but two feet at least one joint failed to fuse, the bolt migrated in six, and four needed revision, which then united. The device could not be recommended in that form; midfoot fixation moved to long beams and plates.

Twenty patients (21 feet) with severe ankle and hindfoot deformity, 15 of them with long-standing ulcers, treated with single-stage correction and a retrograde hindfoot nail. At a mean of 26 months every limb had been saved, 80% of ulcers had healed and all but one patient walked independently. One nail broke and was revised. Standard screws migrated where hydroxyapatite-coated screws did not. Function and quality-of-life scores improved significantly.

A case report. Two and a half years after a steroid injection for severe heel pain, a calcified lump under the skin ulcerated and became infected, leading to a diabetic foot infection that needed a long course of intravenous antibiotics.

The conference abstract of the Foot & Ankle Surgery paper above, reporting the same group of 18 patients (10 with type 1 and 8 with type 2 diabetes) and the same conclusion.

A chapter on the surgical management of Charcot neuroarthropathy, setting out the techniques used and weighing the advantages and disadvantages of operating.

Written with plastic surgeons Camilla Stewart and Naveen Cavale. The chapter covers assessment and optimisation by the team, clearing infection before reconstruction, and how the size, site and anatomy of the defect guide the choice of cover. It follows the reconstructive ladder: healing by secondary intention, split skin grafts, tissue advancement, local rotation flaps and free tissue transfer. The hand-drawn anatomical illustrations used on this site come from this chapter.

The opening chapter of the book, on how a child's tissues respond to injury and how bone heals.

The orthopaedic and trauma chapter of a handbook on obtaining informed consent for common surgical procedures.

A book of single best answer questions with explanatory answers for medical students, combining clinical and basic science questions set in clinical scenarios.

A systematic review of plate fixation for kneecap fractures, the alternative to tension-band wiring. Plating gave satisfactory knee movement, good function and low pain, with a complication rate of 10.4% and uncommon reoperation, mostly to remove metalwork. The authors call for randomised comparison with wiring.

A case report of wireless smart glasses worn during hindfoot nailing for a complex open ankle fracture, displaying live X-ray images in the surgeon's line of sight. The surgeon reported better posture and fewer interruptions, and the signal held throughout.

A review of 42 articles, filtered from just over a thousand, on augmented reality and heads-up displays in orthopaedic surgery. Reported benefits were better accuracy, shorter operations, less radiation and value in teaching. The barriers are cost, the learning curve and usability.

Six surgeons of differing experience assessed ten heel fractures on 2D and then 3D CT, twice, four weeks apart. Adding 3D images improved agreement on classification and on the planned operation, and changed the plan more often. Less experienced surgeons gained most. Since 3D reconstruction adds no cost or radiation, the authors recommend it for planning and teaching.

A rare case in which both hip replacements dislocated at once, followed by a foot drop on one side after closed reduction, with no nerve recovery at six months.

A very rare complication in which the kneecap component of a knee replacement loosened and migrated into the bursa in front of the knee eleven years after surgery.

Thirty-six revision hip and knee replacements, half with a standard dressing and half with a single-use negative pressure dressing at 80 mmHg. Wound complications occurred in three patients with standard dressings and one with the negative pressure dressing, with no dressing-related complications.

A young man developed severe one-sided loin-to-groin pain after weightlifting and was initially misdiagnosed; the cause was acute paravertebral lumbar compartment syndrome. The report describes this rare condition and argues for a systematic approach to loin pain.

An uncommon injury, usually seen in the ring and little fingers. Closed reduction and splinting gave full movement at follow-up.

A review of 14 papers covering 357 patients with simpler wrist fractures treated with intramedullary devices. Function scores were as good as those after volar plating, with a complication rate of 19.6%, no tendon ruptures and temporary radial nerve irritation in 11.4%. The devices are unsuitable for complex joint fractures.

Sixty-eight patients with well-fixed, symptom-free hips: 34 metal-on-metal resurfacings and 34 metal-on-polyethylene replacements. Blood cobalt and chromium were significantly higher after resurfacing and CD8+ T-cell counts were significantly lower, with no evidence that patients came to harm.

A hypothesis paper proposing that reduced movement in the womb, a key signal in joint development, is the common factor across the causes of clubfoot, and that this could simplify how the condition is understood and classified.

A multicentre letter reporting inconsistent practice and limited tissue assessment in gastrointestinal neuromuscular disease.